A Study of Vascular Surgical outcomes in hemodialysis Access.

INTRODUCTION : Vascular Access continues to be a leading cause for hospitalization and morbidity in patients with chronic kidney disease stage 5. An ideal access delivers a flow rate to the Dialyzer adequate for the dialysis prescription, has a large use – life and has a low rate of complications. Studies over several decades consistently demonstrate that native fistula accesses have the best 4 to 5 years patency rates and require the fewest interventions compared with other access type. The present study acknowledges the importance of increasing the number of fistulae in use, but believes that emphasis should be shifted from the fistula construction rate to the rate of usable fistula accesses. This study also detects vascular accesses at risk complication rates and to implement procedures that maximize access longevity. AIM : To study the effect of preoperative duplex mapping on vascular access in hemodialysis patient. To compare the outcome of A.V. Access in patients who were assessed pre-operatively by clinical method versus patients who were assessed pre-operatively both by clinical and duplex scan To study the early patency and early failure rates. To study the reasons for Early failure rates and the complications in A.V. Access. To evaluate the minor modifications in the operative technique to improve the outcome of AV Access. To study the correlation between early postoperative flow rate, vein size and patency based on duplex scan. 48 CONCLUSION : 1) Analyzing the effect of preoperative duplex mapping for Arterial and Venous System: The preference of Arterial and Venous Segment is determined and The failure rates in A.V. Access surgery is decreased. 2) Comparing the outcomes of A.V. Access surgery done based on clinical versus clinical and duplex method, the failure rates inclinical method – 17% failure 14/82 and 10% failure 6/60 in Duplex • The Duplex method seemed to have less failure with statistical significance of P<.001. 3) Studying the failure group, the paediatric and Adult females have more number of failures. • The pediatric population had failures and are statistically significant (11/21 Vs 9/121 – P< .05) 4) The reasons for early failure rates are analyzed and the causes, like, Technical problem at Anastomosis, Hypotension and early spasm contributes 23.5% each. 5) In evaluating the minor modifications in the operative technique, like End to side perpendicular anastomosis, only a small group 23 cases out of 142 are operated and statistical significance not established. The effective use of Basilic vein for AV fistula creation and transposition surgery is a good alternative to synthetic graft. Such procedures are done only in a small group in our study. 6) Studying the early postoperative veinsize and flow rates based on duplex scan, the increase in vein size and flow rates achieved at the end of IV week. However the flow rate and vein diameter measurement by duplex scan is operator dependent and subject to error in cross section area and angle of insonation. 7) In this study, the risk group, which requires definite preoperative duplex mapping are identified. They are – Pediatric Patients, Female patients, Patients with H/o Central Venous Catheterization, Primary procedure failure patients

Iatrogenic vascular injuries: An institutional experience

Introduction: Iatrogenic vascular injuries are emergency referrals to the vascular surgeon. They can lead to prolonged hospitalization, higher cost, limb loss, mortality, and litigation. Aim: The aim of this study is to analyze the referral patterns and outcomes of iatrogenic vascular injuries managed in our institution from 2008 to 2013. Materials and Methods: Patients with iatrogenic vascular injuries referred to the vascular surgery department of our institution from July 2008 to Sep 2013 were included in this study. Those with isolated injury to superficial venous system were excluded from the study. Data were collected from a prospectively maintained database and analyzed with respect to patient characteristics, mode and type of vascular injury, intervention, and outcomes. Results: The incidence of iatrogenic vascular injuries was progressively on the rise year on year during the study period. The incidence was most common in the age group of 31–45 years contributing about 30%. The incidence was more in males (65%). A significant number of iatrogenic vascular injuries occurred in pediatric population (25%). The most common mode of iatrogenic vascular injuries in children was due to intravascular injections and it accounted for 50% of amputations. There was no difference in the incidence among medical and surgical specialties. Conclusion: Iatrogenic vascular injuries appear to progress day by day. Early and proper management can be a limb or life-saving. Late referral ended up in limb or life loss. Thorough knowledge of anatomy and image-guided interventions can be a preventive measure of iatrogenic vascular injuries

Regulating Microvascular Free Flaps Reconstruction in “Schobinger Stage 4” Arteriovenous Malformations of Face

Objectives Arteriovenous malformations (AVMs) are high-flow, aggressive lesions that cause systemic effects and may pose a risk to life. These lesions are difficult to treat as they have a tendency to recur aggressively after excision or embolization. So, it requires a regulating free flap with robust vascular flow averting the postexcisional ischemia-induced collateralization, parasitization, and recruitment of neovessels from the surrounding mesenchyme—a phenomenon precipitating and perpetuating the recurrence of AVM. Materials and Methods Sixteen patients (12 males and 4 females) with AVMs Schobinger type 4 involving face were treated from March 2015 to March 2021 with various free flaps: three free rectus abdominis flaps, one free radial forearm flap, and twelve free anterolateral thigh flaps were used for reconstruction following the wide local excision of Schobinger type 4 facial AVM. The records of these patients were analyzed retrospectively. The average follow-up period was 18.5 months. The functional and aesthetic outcomes were analyzed with institutional assessment scores. Results The average size of the flap harvested was 113.43 cm2. Fourteen patients (87.5%) had good-to-excellent score (p = 0.035) with institutional aesthetic and functional assessment system. The remaining two patients (12.5%) had only fair results. There was no recurrence (0%) in the free flap group versus 64% recurrence in the pedicled flap and skin grafting groups (p = 0.035). Conclusion Free flaps with their robust and homogenized blood supply provide a good avenue for void filling and an excellent regulating effect in inhibiting any locoregional recurrences of AVM